Systematic Review Supports Colchicine for Secondary Prevention of Atherosclerotic Cardiovascular Disease

Is colchicine safe and effective for the secondary prevention of atherosclerotic cardiovascular disease?

The systematic review found that in adults with established atherosclerotic cardiovascular disease, colchicine (Colcrys) reduces the risk of the composite outcome of cardiovascular death, myocardial infarction, and stroke (number needed to treat [NNT] = 114). Colchicine increases the risk of hospitalization for gastrointestinal events (number needed to harm [NNH] = 181), however, there is no overall difference in all-cause mortality or other adverse events. Because of these mixed findings, the authors recommend shared decision-making before prescribing colchicine for secondary prevention. (Level of Evidence = 1a)

The investigators searched multiple databases, including PubMed, EMBASE, and the Cochrane Library, for randomized controlled trials that evaluated the efficacy and safety of colchicine for the prevention of recurrent vascular events in adults with atherosclerotic cardiovascular disease. No language restrictions were applied. Three investigators independently assessed individual studies for eligibility and methodologic quality using a standard risk of bias scoring tool. Conflict resolutions occurred via consensus discussion. Nine trials (N = 30,659) met the eligibility criteria with three trials judged to be at a moderate risk of bias.

The primary outcome—a composite of cardiovascular death, myocardial infarction, and stroke—occurred significantly less in patients treated with colchicine than with placebo (NNT = 114; 95% CI, 74–285). However, only the individual component of reduced risk of myocardial infarction was significant. Among multiple secondary outcomes, the risk of hospitalization for gastrointestinal events occurred significantly more often in patients treated with colchicine (NNH = 181; 99–667). No differences occurred in the risk of other hospitalizations, newly diagnosed cancer, or all-cause mortality. Results remained consistent among various subgroups, including age, sex, diabetes status, and use of statins.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: d'Entremont MA, Poorthuis MHF, Fiolet ATL, et al. Colchicine for secondary prevention of vascular events: a meta-analysis of trials. Eur Heart J. 2025;46(26):2564-2575.